Journal of the American Society of Echocardiography
Clinical InvestigationCarotid Arterial EvaluationWhat Do Carotid Intima-Media Thickness and Plaque Add to the Prediction of Stroke and Cardiovascular Disease Risk in Older Adults? The Cardiovascular Health Study
Section snippets
Study Population
The Cardiovascular Health Study (CHS) is a population-based prospective study of men and women aged ≥65 years at baseline. The mean age of the study population at baseline was 72.8 ± 5.6 years. The overall study design for CHS has been previously published.17 Briefly, between 1989 and 1990, CHS enrolled 5,201 participants using Medicare eligibility lists in four communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania.
Results
Of the 5,888 CHS participants, 1,406 were excluded from the analysis because of the presence of CHD, HF, or stroke at baseline. In addition, 25 were excluded because of missing carotid ultrasound data, and 73 were excluded because of missing data for the clinical covariates. Consequently, the analyses presented included 4,384 CHS participants (61% women, 14% black; mean baseline age, 72 ± 5 years). There were 482 strokes included in this analysis. Of these, 450 were classified as ischemic or
Discussion
Our study has shown that in older adults, the addition of ultrasound measurements of CIMT modestly improves 10-year risk prediction for stroke and CVD beyond the predictive ability of a traditional FRS-type risk model. This improvement is mainly the result of net improvement in down-classifying risk in participants who did not experience incident stroke or CVD. In our elderly cohort, the addition of plaque category to CIMT provided no incremental benefit in risk prediction or reclassification
Acknowledgment
The authors thank Danielle Rivas for her expert assistance in the preparation of this report.
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Cited by (35)
Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification
2017, AtherosclerosisCitation Excerpt :The other two studies [11,12] evaluated the utility of adding a measure of plaque burden to cIMT variables which neither focused strictly on the common carotid artery nor on plaque-free areas. For example, the cIMT variable used in Gardin's analysis [12] was the mean of maximum IMT measurements of several carotid segments (which we define as IMTmean-max), a variable whose values are directly affected by the presence/absence of plaques. A similar comparison previously performed in the IMPROVE cohort [14] produced similar results by showing that the presence/absence of plaque did not add to reclassification when used on top of ultrasonographic variables which incorporate plaques, yet added to reclassification when combined with variables measured in plaque-free areas.
Alpha-2-macroglobulin and heparin cofactor II and the vulnerability of carotid atherosclerotic plaques: An iTRAQ-based analysis
2017, Biochemical and Biophysical Research CommunicationsCitation Excerpt :If multiple types of plaques coexist in one individual, the severest type was adopted. Intima–media thickness (IMT) and plaque score (PS) were also measured using ultrasonography as previously reported [14–16]. A focal region in vessel wall of which the carotid IMT is more than 0.9 mm was considered abnormally thickened.
Association between Cardiovascular Health Score and Carotid Intima-Media Thickness: Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Baseline Assessment
2016, Journal of the American Society of Echocardiography
This research was supported by contracts HHSN268201200036C, N01HC80007, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086 and grant HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by grant AG023629 from the National Institute on Aging. A full list of principal Cardiovascular Health Study investigators and institutions can be found at http://www.chs-nhlbi.org.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Bijoy K. Khandheria, MD, served as guest editor for this report.